MEDICARE: DR. TRANG THI NGUYEN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D8286	OR

General Provider Information

NPI Number	:	1073633434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRANG THI NGUYEN D.M.D.

Provider Business Mailing Address
First Line	:	4429 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6271
Country	:	US
Telephone Number	:	503-384-2799
Fax Number	:	503-384-2797

Provider Business Practice Location Address
First Line	:	4429 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6271
Country	:	US
Telephone Number	:	503-384-2799
Fax Number	:	503-384-2797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/27/2012

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